Remote Clinical Underwriting Specialist

iQor Philippines; Metro Manila; On-site; PHP 800,000 - 1,100,000; Full time

Job summary

iQor Philippines is seeking a Senior Clinical Analyst to favorably impact Stop Loss risk by early identification of potential high-cost patients. You will serve as a subject matter expert evaluating medical information to clarify diagnoses, assess severity, and estimate treatment duration and expected costs.

You will research clinical conditions, provide analytical reviews of medical and pharmacy data, and support rate development to ascertain future risks and guide underwriting decisions.

Qualifications

• Bachelor’s degree and RN license.
• Minimum 5 years of clinical experience.
• Minimum 2 years insurance experience.
• Analytical and problem-solving skills.
• Excellent interpersonal and negotiation skills to act as a company representative.

Responsibilities

• Serve as subject matter expert evaluating medical information to clarify diagnoses and estimate treatment duration and costs.
• Research clinical conditions and provide analytical review of medical/pharmacy data to outline history of events.
• Support rate development with timely clinical analyses to inform underwriting decisions.
• Collaborate with Cost Containment teams to address identified risks and ensure proper handoffs.

Skills

Analytical skills

Problem solving

Negotiation skills

Interpersonal skills

Education

Bachelor's degree

RN license

Job description

iQor Philippines is seeking a Senior Clinical Analyst to favorably impact Stop Loss risk by early identification of potential high-cost patients. You will serve as a subject matter expert evaluating medical information to clarify diagnoses, assess severity, and estimate treatment duration and expected costs.

You will research clinical conditions, provide analytical reviews of medical and pharmacy data, and support rate development to ascertain future risks and guide underwriting decisions.